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Monday, October 10, 2005

Monday Musing: Be the New Kinsey

Last week my wife and I saw the biopic Kinsey in which Liam Neeson plays the entomologist turned pioneering sex researcher, Dr. Alfred Charles Kinsey. It's a pretty good movie. Rent the DVD. Kinsey spent the early part of his career as a zoologist studying gall wasps, on which he became the world's foremost expert. He collected over one million different specimens and published two books on the subject. Then, at some point in the early 30s, while pondering the variety of sexual behavior in the wasps he was studying, he started wondering about the range and variety of sexual behavior in humans. When he looked into it, he was dismayed by the prevalent scientific ignorance about even very basic physiological sexual function in humans, much less complex sexual behaviors. Remember, this was a time when even college-age men and women often had very little information about sex.

But in this vacuum of knowledge where the angels of science feared to tread, as usual, the ever-confident fools of myth and dogma had rushed in with loud proclamations such as: masturbation causes blindness; oral sex leads to infertility; the loss of one ounce of precious, life-giving semen is equivalent to the (rather more obviously enervating) loss of 40 ounces of blood; and so on and on. We've all heard these sorts of things. In addition there was very little information about more real dangers and risks of sexual behavior, such as venereal disease transmission. When Kinsey taught a "marriage" class at the University of Indiana at Bloomington, a type of early sex-ed, his students often asked him questions that he could not answer because the answers simply were not known.

Embarrassment at this state of affairs prompted Kinsey to action. As an accomplished ethologist (one who studies animal behavior in the natural environment) he realized that in addition to studying the physiological sexual equipment of humans and the mechanics of sexual response, it was important to compile data on human sexual behavior "in the wild", and he undertook the prodigious task of conducting detailed surveys of men and women across the 48 states of America to compile statistics about their sexual behavior. He didn't reach his goal of interviewing more than a hundred thousand people, but he did make it to the tens of thousands. I cannot go into the details of his methodology here but it has been fairly well defended. In 1948, Kinsey published the first of two books based on his exhaustive sex research that would eventually alter the course of this country in significant ways: Sexual Behavior in the Human Male. Five years later he published Sexual Behavior in the Human Female.

What Kinsey found is well-known now but was absolutely scandalous at the time: the prevalence of homosexuality and bisexuality; the ubiquity of masturbation, especially in males; the common practice (at least much more than anyone had previously thought) of oral sex, anal sex, premarital sex, infidelity, and other forms of "deviant" behavior. While Kinsey simply reported the raw data, never advocating social policy or drawing moral conclusions, the effects of an open airing of these previously taboo subjects had far-reaching effects, not only contributing significantly to the sexual revolution of the 60s, but, importantly, resulting in the eventual massive decriminalization of various sexual practices such as (but not limited to) sodomy and oral sex across the states. There were other results as well: it took until 1973 for the American Psychiatric Association to remove homosexuality from its list of mental illnesses, but it happened at least partly because of Kinsey's work. Most significant of all, however, Kinsey's reports went a long way toward lifting the clouds of ignorance and fear that had long whelmed sex.

Now it occurred to me after I saw the movie, that there is an area of human practice (and, yes, it is more-or-less universal) which is today covered in the same clouds of ignorance and fear; which has distorted the well-intentioned aims of the criminal justice system and is filling up our jails; and which is dominated by myth and dogma in much the same way sex was before Kinsey had the courage to defy the taboos surrounding it and clear that fog with his bright beam of information: it is drug use.

What is drug use? I shall define it here for my purposes as a consumption (whether by ingestion, inhalation, injection, absorption or any other means) of a substance with little or no nutritional benefits, simply out of a desire for its effect on the nervous system. This then includes substances ranging from caffeine and nicotine, to alcohol, marijuana, LSD, PCP, ecstasy, cocaine, crystal meth, heroin, and the thousands of other substances that people use to enhance, or at least alter, their subjective experience of the world. And I won't even get into prescription drug (ab)use from Valium to Viagra. Extremely large portions of all the cultures that I know of use at least some of these and other substances. Of course, most people enjoying a friendly chat over tea are not explicitly aware that they are taking a drug, but they are, and it makes them feel better, more energetic, and more awake. Just as some sexual practices are relatively harmless, while others pose real dangers to those who practice them, certain drugs and related practices are more dangerous than others.

Here's the problem: there is very little useful information available about drugs. The reason is that there is a reluctance bordering on taboo on the part of government and non-government agencies alike to actually spell out the risks of taking drugs. In the case of illegal or other "bad" drugs, there is an absolute refusal to accept the fact that a large part of the population uses and finds pleasure in these substances, and an attempt to marginalize all drug users as criminals, addicts, and degenerates; just as in Kinsey's time, absolute abstinence is at present the only acceptable message for the public. "Just say no!" That's it. Where there should be informed messages of the exact risks of various substances, there is fear-mongering instead: the "this is your brain on drugs" ad on TV showing a frying egg, for instance. The implication is, just as an egg cannot be unfried, once you have used drugs (which drugs? how much? for how long? --these questions are not to be asked, and cannot be answered), your brain is permanently fried, whatever that means. After all, a fried brain is just a metaphor, it does not say anything scientific about exactly what sort of damage may be done to one's brain by how much of what drug over what period of time. "Cocaine Kills!" is a common billboard ad. Have you noticed that Kate Moss hasn't died? Why? I happen to know a bunch of Wall Street types who have been snorting lines off little mirrors in the bathrooms of fancy downtown clubs pretty much every weekend for at least a decade, and so, probably, do you. None of the ones I know have died so far. I also know a man who tried cocaine for the first time and ended up in an emergency room. So what is the real risk?

The problem with just telling people "Cocaine Kills!" and nothing more is that because they may see many people doing cocaine who are not dropping like flies, they completely dismiss the message as a crying of wolf. Or, they may think, "Yeah, sure cocaine kills, but so does skiing. Think Sonny Bono. Think Michael Kennedy. Just say no to skiing? I don't think so. The pleasures outweigh the risks for me." Why not tell them something useful about what the real statistical risks are? What percentage of the people who do it die from cocaine? What are the chances of dying for every ten times, or a hundred, or a thousand that you take cocaine? In the almost religious zeal to curb smoking, even there the situation about the actual risks is endlessly confusing. I have repeatedly read that 9 out of ten people who have lung cancer were smokers, but this tells me nothing about what risk I am taking of getting lung cancer by smoking. It could be that only a small percentage of the population gets lung cancer, and of those, the smokers are at disproportionately higher risk. There are hugely inflated figures of the number of deaths caused by smoking which are routinely thrown around. I have even seen a poster claiming that 3 million people are killed every year in the U.S. by smoking. That's more than the total number of deaths every year in the U.S.! What I would really like to know is, on average, how much I am shortening my life with every pack-year of cigarettes I smoke? I just looked at various websites such as those of the American Heart Association, the Centers for Disease Control, the World Health Organization, and countless others, and I cannot find this simple information. Why? Just as Kinsey could not answer many of his students' questions about sex, if a young person today asks just how risky it is to use ecstasy at a rave, for example, we have nothing to say.

Another problem with this "just say no" approach is that just as the total abstinence approach masks the differences in danger to one's health of different sexual practices (having frequent unprotected sex with prostitutes is obviously not the same risk as having protected sex with a regular partner) because they are equally discouraged, this approach also masks the differences between the various practices of using drugs. Smoking a joint is not the same as mainlining heroin, but there is no room for even such crude distinctions in this simplified message. There is only the stark line drawn between legal and illegal drugs. Go ahead and have your fourth martini, but, hey, that hash brownie will kill you!

The same unrealistic refusal to acknowledge that drug use is very common (yes, there are always a few polls of high school sophomores and college freshmen, but nothing serious and comprehensive) across all strata of society results in a distorted blanket approach to all drug use, and the same ignorant fear-mongering that used to exist about sex. The first thing to do is to compile, like Kinsey, detailed information on all drug use (or at least the top twenty most used drugs) by employing the best polling techniques and statistical methods we have. Let's find out who is using what drugs, legal or illegal. Break it down by age, gender, race, income, geographical location, education, and every demographic category you can think of. Ask how often the drug is taken, how much, in what situations. Ask why the drug is taken. What are the pleasures? Poll emergency rooms. Research the physiological effects of drugs on the human body. Write a very fat book called Drug Taking Behavior in the American Human. I am not advocating any policy at all. I am just advocating replacing ignorance and confusion with irrefutable facts. New directions will suggest themselves once this is done. Maybe just as people who engage in oral sex are no longer seen as perverts and degenerates, maybe one day Bill Clintons won't have to say "But I didn't inhale," and George W. Bushes won't have to lie about their cocaine use. On the other hand, maybe we will decide as a society that Muslims were right all along, and ban alcohol. Go ahead, be the new Kinsey.